Drastic Thinness Has Become the Reigning Beauty Ideal from Runways to the Red Carpet—and It's Having An Alarming Effect on Girls Everywhere

At a party for designer Zac Posen in New York City on Sept. 14, the scene was fashion meets young Hollywood. There was Kate Bosworth looking whisper-thin in a black dress, dancing to Justin Timberlake's "SexyBack" and smoking cigarettes. There was the always minuscule Mary-Kate Olsen, who stopped by just long enough to puff a cigarette and pose for a few photos. At the center was Posen, 25, a current red-carpet favorite who has dressed a range of young actresses, from the plus-size Marissa Jaret Winokur to the sub-zero Bosworth. "I like women's bodies—I emphasize them in my clothing," Posen told PEOPLE on Sept. 21. "Healthy women are much sexier."

And yet the questions of who is healthy and what is sexy cut to the heart of a renewed debate that is currently raging everywhere from message boards to movie sets to modeling agencies. What makes this controversy new is that for the first time both designers and stars have been put on the defensive: In Hollywood, stylemakers like Bosworth, 23, and Nicole Richie, 25, are setting troubling new standards for thinness, while in the fashion world, frail-looking runway models drew gasps at New York City's Fashion Week. "In the past, some young models have had issues with eating disorders—but they were rapidly singled out and left with very little options other than to address their problem," says David Bonnouvrier, head of DNA Model Management. "The latest trend of skinny models, however, has allowed many of these young women to continue working, living in total denial." Adds Dr. Ira Sacker, a Manhattan-based eating disorder specialist and the coauthor of Dying to Be Thin: "I have a lot of A-list celebrities as clients, both actresses and models, and what they are telling me is that the pressure to be thin has never been greater. Why? Because whoever is thinner gets the job, and the competition is enormous."

To be sure, scrutiny of the thinnest stars is more intense than ever. On Sept. 25 Richie went so far as to issue a denial on her MySpace page after a false report surfaced that she'd checked herself into an eating disorder clinic: "I do not have an eating disorder, and I don't know how many times I have to say it. I've repeated myself so many times, I feel like a broken record.... I am happy, and healthy, and living my life."

In the wake of Madrid Fashion Week's controversial ban on underweight models (see box), battle lines have been drawn in Hollywood and the fashion world. There are those like model Frederique van der Wal, 39, host of TLC's style show Cover Shot, who in her heyday walked for Ralph Lauren and Donna Karan but says, "This season, it seems they went too thin on the runway—I could have never been in the uniform of what you see today." Others, however, are crying foul at Spain's stance, which has drawn support in countries like India and Israel but was flatly rejected by major fashion capitals Paris and London. "I think it's not fair that people who can be naturally thin are getting attacked for it," says superstylist Rachel Zoe, 35, who has been criticized for her roster of skinny clients—including Richie, Lindsay Lohan and Mischa Barton—even as she transforms them into Gen-IM style icons. Has she ever suggested to any of her clients that they lose a few pounds in the name of fashion? "Not in a million years," says Zoe, "would I do that."

So who is responsible for the heightened pressure to get thin? Stylists and fashion-show bookers blame designers for creating clothes that barely fit a size 2. "Maybe back in the day a size 6 could slide through, but [recently] it really has been a 2/4 dress size," says casting director Drew Linehan, who booked models for 12 shows during New York's Fashion Week. Designers, meanwhile, blame the bookers for hiring young, barely pubescent models, and models blame their alien metabolisms for keeping them insanely thin. In the midst of all the finger-pointing, experts are sounding the alarm: A new poll of college students conducted by the National Eating Disorders Association found that a shocking 20 percent of respondents had at some point suffered from an eating disorder. Additionally, "I am seeing younger and younger girls being affected—as young as 8 years old," says Carolyn Costin, director of the Monte Nido Treatment Center in Malibu.

Compounding the persistent cultural emphasis on skinniness is the fact that actresses are increasingly replacing models as designer muses and spokesmodels (Bosworth, for example, represents Revlon) and are feeling heightened stakes when they turn up at awards shows. "When you're walking down [the red carpet], there are truly like 100 photographers, and you do want to look your best," says Curb Your Enthusiasm's Cheryl Hines.

The result can be a saturation of relentlessly thin images from movies to magazines. "Young girls see celebrities losing weight, and the more famous they are, the more weight they lose," says Costin. "It creates a climate that says it's unnatural to be a natural size."

In interviews with PEOPLE at malls across the country, most teenage girls rejected Richie's body as "nasty" and "too skinny" but acknowledged that she and other stars serve as style role models. "Nicole's body is gross because her skeleton shows," says Kailey Koepplin, 17, of Eden Prairie, Minn. Other teens said they admire healthier-looking stars like Jessica Simpson ("She has cute clothes and she doesn't show too much"), Beyoncé and Jessica Alba ("She's tiny, but she's not too tiny").

Of course, the ongoing thin-thinner-thinnest sweepstakes is as much a part of certain fashion and showbiz circles as coffee and cigarettes. But beyond those perennial appetite suppressants, experts and industry insiders alike say that some Hollywood starlets—in an attempt to out-thin their runway counterparts and each other—are adopting drastic ways of slimming down. "There are a lot of girls taking horse tranquilizers, which are so incredibly dangerous," says former View cohost Debbie Matenopoulos, 31, who now cohosts Daily 10 on E! Adds Sara Albert, 23, a finalist on last season's America's Next Top Model who has been working steadily since then: "There's a huge drug scene. You have to have energy to model, but if you're not eating ... So yeah, people turn to different methods of staying skinny."

Such talk is an open secret in Hollywood, says one source who has worked closely with a number of young celebrities. "If you're in these circles, people aren't quiet about it," says the source, who says the prescription ADHD drug Adderall XR has become a weight-loss favorite. "To them, taking a diet pill is like drinking a beer. It has simply become an acceptable part of the young Hollywood culture."

In an era when even healthy-looking stars like Reese Witherspoon and Jennifer Lopez provoke pregnancy chatter at the slightest appearance of a less-than-taut tummy, stars say the pressure to be hyperthin is out of control. And with television stars like Jaime Pressly and Portia de Rossi (see box) opening up about their struggles to conform to Hollywood standards of slimness, the question of how far TV pushes actresses has taken on new urgency. "Does [TV] put pressure on [actresses] to become anorexic? No," says Desperate Housewives' star Felicity Huffman, 43, who has talked of battling bulimia and anorexia in her teens and early 20s. "Does it put pressure on them to become excruciatingly thin? Yes."

Like many actresses who hit it big on television or in film, Huffman herself appears noticeably slimmer since she started on Housewives three years ago. "You get so nervous about the way you look [on TV] that you just get skinnier and skinnier—it's happened to me a bunch of times," says actress Lea Thompson, 45. "Any stomach shows."

If that kind of extreme pressure is unlikely to change anytime soon, some stars are hoping that by bringing it out into the open, progress will come slowly—even if it means acknowledging their own insecurities. At the Emmys this year, Matenopoulos says she was three pounds heavier than she'd recently been. "I tried my hardest to look in the mirror and say, 'You know what? Nobody's gonna be able to tell you've gained three pounds,'" she says. "And nobody noticed—except for me, in my ridiculous little head."

PORTIA DE ROSSI
HOW I BEAT ANOREXIA
This is a good opportunity for me to say, "Do as I say, not as I do," because I've had firsthand experience with being caught up in the whole Hollywood body thing. When I got the job on Ally McBeal, it was because I was healthy and attractive at my natural weight. But every single day, you're basically in fittings, constantly being measured. Plus, I thought by losing weight, it would be one less thing I had to think about—when it came to award shows, I didn't have to worry about if I would fit into a sample size. I got caught up trying to maintain that. I would eat 300 calories a day—a lot of Jell-O and no-sugar everything, of course. I was also doing Pilates, weight-training, circuit training; over lunch, I would run on my treadmill in my dressing room with a fan on my face so I wouldn't sweat my makeup off.

I realized something was drastically wrong when I stepped on the scale at the end of 1999 and saw 82 lbs. It became a struggle just to feel good. Then I went back home to Australia, and my brother and mother said, "You're going to die." It really woke me up; I had to do something, or I was going to lose everything. I went to a counselor and saw it for what it was—an eating disorder.

Gradually I increased the amount of food I ate. Everything I put in my mouth, my body clung to in gratitude. It took four years, but I remember waking up one morning and thinking, "Oh my God. My first thought isn't 'What did I eat last night?'" Now I never, ever put restrictions on food. I stopped exercising for the sake of losing weight, and I don't go on the scale. I don't really regret much in my life, but I will never get the time back I spent worrying what the scale said.

KATE BOSWORTH2002
Fresh off her Blue Crush breakthrough, the actress—a champion equestrian as a teen—appeared slender but fit.
2006
As a leading lady at a premiere in June, her face, bust, arms and waist were notably thinner.

CHRISTINE TAYLOR
2001
Taylor, then known for playing Marcia Brady on the big screen, flaunted her curves.
2006
Now 35 and a mom of two (with husband Ben Stiller), she has said her kids keep her active.

KIM RAVER
2003
The future 24 star (then appearing on NBC's Third Watch) looked lithe but healthy.
2006
Now on ABC's The Nine, Raver, 39, works out with celeb trainer Valerie Waters.

MODELS: THEN & NOW
1990
A curvy Cindy Crawford, then 24, strutted her stuff in a Paris show.
2006
Ukrainian model Snejana Onopka, 19, worked the pin-thin look at Miss Sixty in N.Y.C.

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Julie Jordan Jenny Sundel/L.A.,

Jed Dreben/L.A.,

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Jessica Herndon/L.A.,

Jeffrey Slonim/New York City,

Steve Erwin/New York City,

Nina Burleigh/New York City,

Kelly Carter/New York City,

Kristen.

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Celebrities Sound Off

"I'd be lying if I said I wasn't curious to see how thin I could get.... I felt awful." —Angie Harmon

"I did a movie with Chris Rock who said, 'I know you want to lose weight because you're supposed to be sexy, but I don't want you to." —Kerry Washington

"There's pressure to stay thin for every actress and unfortunately every American woman." —Debra Messing

What's Too Thin?

The key methods doctors use

"There's no universal scale" to determine what's a healthy weight, says Celebrity Fit Club's Dr. Ian Smith. But the gauge often used is the body-mass index (BMI), which is based on a person's height and weight. A BMI between 18.5 and 24.9 is considered normal (between 108 and 145 lbs. for a 5′4″ woman); Madrid officials used a BMI cutoff of 18 to determine which models were too thin. Others, however, insist, "Healthy weight is not a number," as Dr. Doug Bunnell of the Renfrew Center's eating disorder clinic in Wilton, Conn., puts it. "The clear marker of unhealthy weight loss is if [a woman] loses her period," he says, adding at this level there's a risk of problems like osteoporosis and infertility.

What Readers Are Saying on People.com

"No matter how confident a woman can be, there are times she will compare herself to that image [of superthin stars] and wonder what she has done wrong, why she doesn't match it." —Erica

"I don't feel that 'curvy' women should be celebrated for their figures, nor should 'skinny' women be criticized for theirs. Let's take the focus off of women's bodies ENTIRELY." —Amanda